Provider Demographics
NPI:1285659193
Name:FISHER, W. JUD (DO)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:JUD
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2419
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:821 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5339
Practice Address - Country:US
Practice Address - Phone:702-438-4003
Practice Address - Fax:702-438-0555
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00853500OtherRAILROAD MEDICARE
NV1285659193Medicaid
NVDJ927ZMedicare PIN